The Massachusetts Health Reform Law: Public Opinion and Perception

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1 The Massachusetts Health Reform Law: Public Opinion and Perception A REPORT FOR THE BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION November 2006 Robert J. Blendon Tami Buhr Channtal Fleischfresser John M. Benson Harvard School of Public Health

2 The Massachusetts Health Reform Law: Public Opinion and Perception A REPORT FOR THE BLUE CROSS BLUE SHIELD OF MASSACHUSETTS FOUNDATION November 2006 Robert J. Blendon Tami Buhr Channtal Fleischfresser John M. Benson Harvard School of Public Health

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4 Contents Executive Summary Introduction Methods The State of Health Care in Massachusetts Public Awareness of Health Reform Law Support for the Health Reform Law Elements of the Health Reform Law Impact of the Law Public Opinion on Fairness of Health Reform Insurance Premiums Implications for the Future Complete Survey Results About the Authors Funding for this report was provided by the Blue Cross Blue Shield of Massachusetts Foundation. The views presented here are those of the authors and should not be attributed to the Foundation or its directors, officers, or staff. Additional copies of this report are available upon request. Please contact the Blue Cross Blue Shield of Massachusetts Foundation at or

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6 Executive Summary The new Massachusetts health care reform law puts the Commonwealth at the national forefront of health care reform. The law, enacted in April 2006, is intended to increase health insurance coverage through a combination of Medicaid expansions, government subsidies, health insurance market reforms, and a requirement that individuals purchase health insurance coverage if affordable coverage is available. In addition, employers with more than 10 employees will be required to either make a fair share contribution towards the cost of coverage or pay an annual assessment per employee. As the law is implemented, public support will be critical to its success. A new survey of Massachusetts residents finds the public is largely supportive of the new law (64%), with support widespread across a variety of demographic groups. The uninsured, the poor, younger adults, and minorities, all groups likely to be impacted most by the law, are not significantly more or less in favor of the law than other Massachusetts residents. When compared with other major health care reform proposals, the Massachusetts health reform law is more popular among the public six months after its passage than the other proposals were at similar points in their histories. Most provisions of the law are quite popular. Massachusetts residents overwhelmingly support an expansion of MassHealth to cover more uninsured children (88%). The public is also highly supportive (70%) of the parts of the law that require businesses to do more. Public support for the state requiring individuals to purchase insurance is more mixed, with 52% supporting the new requirement. The public is divided about the individual mandate, with some of the more directly affected groups, such as people with lower incomes and minorities, who are more likely be uninsured, opposing it. Though this requirement to purchase insurance will have a greater impact on the uninsured and younger adults, who are less likely to have insurance, there is no significant difference in support by insurance status or age, with a slight majority of both the uninsured and young adults expressing support for the provision. The public s views on the individual mandate point to a need for both widespread education about the new requirement and for the new Commonwealth Health Insurance Connector Authority to exercise care when establishing the affordability standards for the individual mandate to ensure that those standards are viewed as fair by the public. The survey also asked respondents about their views on whether or not the premiums established for the subsidized insurance program, called Commonwealth Care, and the likely prices for the Connector-offered plans were reasonable. A sizable majority of the public feels the Commonwealth Care plan premiums for lower income residents are reasonable. The public is also supportive of prices within the range of those that have been publicly discussed for Commonwealth

7 The Massachusetts Health Reform Law: Public Opinion and Perception Connector-offered plans for uninsured residents who do not qualify for the subsidized plans. Yet, the survey also shows that increases in premiums could shift opinion from supporting to opposing the Commonwealth Care and Connectoroffered plans. If the premiums start to rise over time and are perceived by the public to impose an unreasonable hardship, public support for the new law could erode. Massachusetts residents are divided on whether the new health reform law will meet the objective of providing health insurance for all. A slight majority (54%) believes the law will succeed, while 42% believe it will not. In addition, a slight majority of the public (56%) believes the law will help improve the availability of affordable health care. This skepticism reflects a more general cynicism among the public about the government s ability to solve tough problems. Making sure implementation goes smoothly will help the public gain confidence in the plan and dispel concerns about the government s capacity to implement. It will be important for the Connector Authority and other government agencies responsible for implementing the law to meet visible deadlines and issue progress reports that are widely circulated throughout the state. While a large majority of respondents (70%) believes their taxes will go up as a result of the law, a majority of those who believe their taxes will increase are still in favor of it. This rare combination of public support for a program expected to increase taxes indicates a public commitment to the goal of providing health care for all Massachusetts residents. It also suggests an acknowledgement of the partnership among the public, employers, and government required to meet that goal. Massachusetts residents are split on whether the economy will be helped or hurt by the new health reform law. One in three feel the economy will be hurt (33%), just over one in four say it will be helped (28%), and another one in three (32%) believe the law will not have much impact on the economy. The survey also asked Massachusetts residents whether the law will help, hurt, or not have much impact on seven different groups. A majority believes that the law will help the uninsured (67%) and the poor (66%). Nearly two in three (63%) expect small businesses to be hurt by the law. In the long-term, the earlier debates surrounding employers financial responsibilities in the new law could resurface if economic conditions worsen in the state and small businesses are seen as adversely affected. It will be important for the Connector Authority to develop and maintain a close relationship with the small business community so that its concerns can be heard and addressed. Despite these challenges, the widespread support for the Massachusetts health reform law is reason for optimism for its future if leaders can combine public support with a highly visible continuation of the implementation work already under way.

8 Introduction The new Massachusetts Health Reform Law puts the Commonwealth at the national forefront of health care reform. The law, passed and signed in April 2006, is intended to increase health insurance coverage through a combination of requiring individual coverage, employer responsibilities, and government assistance. The program will be phased in gradually with full implementation scheduled for July The opinions of elected officials, business leaders, and public interest groups have been widely heard due to the extensive media coverage surrounding passage of the law. Yet the opinions of the broader Massachusetts public have been unknown until now. As the law is implemented, public support of the reform plan will be critical to its success. This report presents the results of a recent survey of Massachusetts residents on their views of the new health care reform law. The report will examine seven main questions: (1) What are Massachusetts residents views of the state of health care in the Commonwealth today? (2) How aware is the public of the new health care law? (3) What is the level of public support for the new law, overall and among key groups? (4) How does the public feel about the different elements of the new law? (5) What impact do Massachusetts residents think the law will have on the number of uninsured in the state, health care costs and quality, their taxes, and the economy? (6) Who do Massachusetts residents believe will be helped by the law and who will be hurt? (7) What do Massachusetts residents believe is a reasonably priced health plan for the uninsured? Methods The data presented here are derived from a telephone survey of the Massachusetts public. The survey was designed by a team of researchers at the Harvard School of Public Health. The instrument was approximately 18 minutes in length. Respondents could choose to have the interview conducted in either English or Spanish. Interviews were conducted via telephone with 1,031 randomly selected Massachusetts state residents age 18 and older by International Communications Research of Media, Pennsylvania. The interviewing period was September 11 18, The data were weighted to accurately reflect the demographics of the state s adult population as described by the U.S. Census. When interpreting these findings, one should recognize that all surveys are subject to sampling error. Results may differ from what would be obtained if the whole Massachusetts adult population had been interviewed. The size of this error varies with the number of persons surveyed and the magnitude of difference in responses to each question. The sampling error for surveys of 1,031 respondents is ±4 percentage points.

9 The Massachusetts Health Reform Law: Public Opinion and Perception The State of Health Care in Massachusetts The law was enacted at a time when a majority of Massachusetts residents believe that the health care system in Massachusetts has serious problems. Forty-five percent believe that the health care system in Massachusetts has major problems, while 14% think that it is in a state of crisis. Only 8% of Massachusetts residents believe that the health care system does not have any problems. Compared to a survey from 2003 before the law was passed, public opinion on the state of the system has improved slightly. 1 Although the same proportion of people feels the system is in crisis, there has been a decline in the proportion who feels the system has major problems (Exhibit 1). In addition, Massachusetts residents are less critical of the state s health care system than the national public is about the U.S. health care system (Exhibit 2). Exhibit 1 Public beliefs about the health care system in Massachusetts today It is in a state of crisis Percent Saying 14% 14% It has major problems 45% 58% It has minor problems 27% 25% It does not have any problems 8% 1% Harvard School of Public Health/BCBS of Mass. Foundation/Cogent Research 2003 Note: Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Exhibit 2 Public beliefs about the health care system in the United States today Percent Saying It is in a state of crisis 14% 22% It has major problems 45% 52% It has minor problems 19% 27% It does not have any problems 8% 4% Massachusetts United States Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Note: Don t know responses not shown Harvard School of Public Health/Robert Wood Johnson Foundation Poll, August 2006

10 5 Public Awareness of Health Reform Law The survey asked Massachusetts residents how much they have heard or read about the new universal health insurance law. Most Massachusetts residents (80%) are aware of the new law, but few have heard very much about it. Only 7% have heard a great deal about the law, while 15% have heard quite a bit. Slightly over one-quarter have heard just some. Close to one-third have heard only a little (Exhibit 3). Exhibit 3 Familiarity with the Massachusetts Health Reform Law Have heard of law Percent Saying Only a little 29% Just some 28% Quite a bit 15% 7% 80% Have not heard of law Nothing at all 20% A great deal Note: Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

11 6 The Massachusetts Health Reform Law: Public Opinion and Perception Support for the Health Reform Law A majority of Massachusetts residents support the new health care law. The survey asked about support for the new law in two ways. First, respondents were asked in general terms whether they supported or opposed the law. Next, they were read a summary description about the law and again asked their opinion. This latter question more closely represents what people will learn when they hear about the law in the news media in coming months. The question was worded as follows: I m going to give you some background information on the new law. As the law is written, the cost of the new Massachusetts Universal Healthcare Law would be shared by the state government, the uninsured, and employers. Everyone who doesn t have health insurance would have to buy it or pay a penalty. Those who can t afford insurance would be able to purchase a discounted plan through a state agency. Many low-income people would receive their insurance for free. All employers, with the exception of the smallest businesses, will have to provide insurance for their employees or pay a penalty. Based on what we have told you, do you support or oppose this new health insurance law? Regardless of the question asked, a majority of people support the law 61% in response to the general question and 64% when given more information (Exhibits 4 and 5). Approximately one in four oppose the law (20% general question, 28% with more information). Exhibit 4 Support for the new Massachusetts Health Reform Law Base: Respondents who are familiar with the law Support Percent Saying 61% Oppose 20% Don t know 18% The percentages do not add up to 100% due to rounding Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Exhibit 5 Support for law after hearing description of its provisions Support Percent Saying 64% Oppose 28% Don t know 8% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

12 7 Support for the new law is consistent across a wide variety of demographic groups. At least a majority of all groups support the law (Exhibit 6) and they do not vary significantly in their degree of support. The uninsured, the poor, younger adults, and minorities, all groups likely to be impacted most by the law, are not significantly more or less in favor of the law than other Massachusetts residents. Exhibit 6 Support for law after hearing description of its provisions Total Percent Saying 64% 65+ year-olds 56% year-olds 69% year-olds 66% year-olds 61% Income > $75k+ 67% Income < $25k 60% Whites 65% Minorities Insured continuously in last 12 mo. Uninsured at some point in last 12 mo. Self-employed household 62% 65% 62% 63% Healthcare job household 63% *Statistically significant difference from 65+ year-olds at p<.05 Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

13 8 The Massachusetts Health Reform Law: Public Opinion and Perception Elements of the Health Reform Law In essence, the new Massachusetts health reform law is one of shared responsibility among individuals, employers, the Commonwealth, and the federal government. Universal coverage will be achieved through the contributions and commitments of all four. The new law requires that all uninsured Massachusetts residents with access to affordable health coverage either purchase health insurance or pay a fine of up to 50% of what health insurance would cost. Individuals and families whose incomes are up to 300% of the federal poverty level (FPL) will receive varying levels of government subsidies to help them purchase insurance called Commonwealth Care. Three hundred percent of the FPL is $29,412 a year for an individual and $60,012 for a family of four. Commonwealth Care enrollees with incomes at or below 100% FPL, which is $9,804 for an individual and $20,004 for a family of four, will not be charged a premium. Commonwealth Care enrollees with incomes between 101% and 300% FPL will be charged a premium based on a sliding income scale. In addition to the new subsidized program, the state will expand MassHealth, the public insurance program for low income and disabled people, to cover children whose family incomes are up to 300% FPL. Businesses that employ more than 10 employees will have new responsibilities. They will need to provide insurance for their employees and make a fair and reasonable contribution to its cost, 2 or pay a fee of up to $295 per employee per year. These employers will also be required to offer a cafeteria plan through which employees can purchase health insurance with pre-tax dollars. The survey finds that public support of the different provisions of the law varies (Exhibit 7). Massachusetts residents overwhelmingly (88%) support an expansion of MassHealth to cover more uninsured children. The public is also highly supportive of the parts of the law that require businesses to do more. A large majority (80%) favor requiring businesses that employ more than 10 people to set up programs so that employees can purchase insurance with pre-tax dollars. A smaller but still large number of people (70%) favor requiring these businesses to provide coverage for their employees or pay a penalty. Leading up to the law s passage, the greatest political controversy surrounded requiring businesses to provide insurance for employees or pay a penalty. The survey finds little public controversy on this measure. Both the employer insurance contribution and cafeteria plan requirements receive majority support from a wide variety of groups. Exhibit 7 Summary of support for provisions of law Expanding MassHealth to cover more uninsured children? State government requiring employers to be part of this pre-tax program to allow workers to set aside money for insurance before taxes? Percent Saying 88% 80% Requiring businesses to provide health insurance or pay a penalty? State government requiring uninsured residents to purchase health insurance? 52% 70% Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

14 9 The least popular provision is the individual insurance purchase requirement. A slim majority (52%) favors requiring uninsured adults to purchase insurance or pay a fine. Support for the individual mandate varies by income. Lower income people are the least supportive of the individual requirement to purchase insurance. As shown in Exhibit 8, Massachusetts residents who make less than $25,000 are more likely to oppose than support it (49% versus 43%). Upper income residents, who comprise approximately half of the state s residents, are significantly more supportive than people earning below $50,000 a year. Whites are also more likely to support it than minorities (54% versus 44%). Though this requirement will have a greater impact on the uninsured and younger adults, who are more likely to lack insurance, there is no significant difference in support by insurance status or age. Exhibit 8 Support for requiring uninsured residents to purchase health insurance Percent Saying Income $75k+ 60%* 37% Income between $50k 74.9k 36% 58% Income between $25k 49.9k 47% 49% Income less than $25k 43% 49% Support Oppose *Statistically significant difference from both income less than $25k and income between $25k 49.9k at p<.05 ºStatistically significant difference from income $75k+ at p<.05 Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

15 10 The Massachusetts Health Reform Law: Public Opinion and Perception Impact of the Law Overall The new Massachusetts law has three stated goals cover the uninsured, contain costs, and increase the quality of care. Massachusetts residents are divided on whether the new health care law will meet the objective of providing health insurance for all. A slight majority (54%) believes the law will succeed in providing health insurance for all residents, while 42% believe it will not (Exhibit 9). Exhibit 9 Public confidence that the new Massachusetts Health Reform Law will ultimately provide health insurance for all Massachusetts residents Yes it will Percent Saying 54% No it won t 42% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Health Care Costs and Quality The growth of health care costs continues to outpace the growth of workers wages and other goods and services. 3 The Massachusetts health care reform law hopes to contain future costs and make health care more affordable in several ways: (1) By expanding coverage and bringing healthier people into the insurance pool, costs should be more stable for everyone. (2) Insuring the currently uninsured will allow them to seek less expensive preventative and primary care rather than wait and receive care in emergency rooms when their condition is more serious. (3) By merging the non-group and small-group insurance markets, the costs of insurance for the non-group market are expected to decline significantly. A slight majority of the public (56%) believes the law will help with the availability of affordable health care. Eighteen percent are pessimistic and think the law will actually hurt the availability of affordable health care, and another 19% feel the law will not have much impact (Exhibit 10). Exhibit 10 Public confidence that the new Massachusetts Health Reform Law will help the availability of affordable health care in Massachusetts Will help Percent Saying 56% Will hurt 18% Not much impact 19% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

16 11 Opinion is more divided on the impact of the law on health care quality. Just over one in three (37%) feel that the quality of health care will be improved by the law, the same percentage (37%) do not think quality will be affected, and one in five (19%) feel that quality will be hurt by the law (Exhibit 11). Exhibit 11 Public confidence that the new Massachusetts Health Reform Law will help the quality of health care in Massachusetts Will help Percent Saying 37% Will hurt 19% Not much impact 37% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Taxes and the Economy The public is generally in agreement on the impact of the new law on their taxes. A large majority (70%) feel their taxes will go up as a result of the law (Exhibit 12). There is widespread agreement across a variety of demographic groups that their taxes will go up; however, support for the law withstands the belief that it will increase taxes. A majority of people who feel their taxes will go up (60%) support the new health reform law. Opposition to the greater employer responsibilities in the new law has been based in part on the impact these requirements might have on the economy if they create a negative business environment. Supporters have argued that the law will create a more positive environment by helping to control health care costs. While public opinion shows a relatively high level of support for the employer responsibilities in the law, public opinion is divided on the impact the law will have on the state s economy. Massachusetts residents are split on whether the economy will be helped or hurt by the new health reform law. One in three (33%) believe the economy will be hurt, just over one in four (28%) say it will be helped and another one in three (32%) believe the law will not have much impact on the economy (Exhibit 13). Exhibit 12 Public belief that the new Massachusetts Health Reform Law will cause taxes to go up Go up Percent Saying 70% Go down 1% No impact 23% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

17 12 The Massachusetts Health Reform Law: Public Opinion and Perception Exhibit 13 Public confidence that the new Massachusetts Health Reform Law will help the Massachusetts economy Will help Percent Saying 28% Will hurt 33% Not much impact 32% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 The Impact on Individuals: Who Will the Law Help and Who Will It Hurt? Because the Massachusetts health reform law splits responsibility for health insurance among individuals, employers, the Commonwealth and the federal government, its impact could be widespread. The survey asked Massachusetts residents whether the law will help, hurt, or not have much impact on seven different groups plus the respondent personally: people who are uninsured, poor people, young adults, the middle class, people who are insured, large corporations, and small businesses. A majority of Massachusetts residents believe that the law will help the uninsured (67%) and the poor (66%). Fifty percent feel young adults will be helped (Exhibit 14). Exhibit 14 People who think the law will help People who are uninsured 67% Poor people 66% Young adults 50% The middle class 27% You personally 20% People who are insured 17% Large corporations 15% Small businesses 14% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

18 13 With the exception of small businesses, the public does not expect many groups of people to be hurt by the law. Nearly two in three (63%) expect small businesses to be hurt by the law. A majority of the public did not think the law would harm any of the six other groups (Exhibit 15). Most Massachusetts residents (60%) believe the law will not have much impact on them personally. Few expect the law will help (20%) or hurt (18%) them. The uninsured are the exception. A majority of the uninsured believe the law will impact them, but opinion is mixed on whether that impact will be positive or negative (42% positive v. 30% negative) (Exhibit 16). Exhibit 15 People who think the law will hurt Small businesses 63% The middle class 28% Young adults 19% People who are insured 19% You personally 18% Large corporations 18% Poor people 17% People who are uninsured 15% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Exhibit 16 Public confidence that the new Massachusetts Health Reform Law will help you personally Will help Will hurt Percent Saying 16% 16% 30% 42% Insured continuously in last 12 months Uninsured at some point in last 12 months Not much impact 26% 66% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

19 14 The Massachusetts Health Reform Law: Public Opinion and Perception Public Opinion on Fairness of Health Reform Insurance Premiums A key feature of the new health insurance reform law is the requirement that individuals purchase insurance if affordable coverage is available to them. Massachusetts residents who do not have insurance and whose incomes fall below 300% FPL may be eligible for a state subsidized insurance program called Commonwealth Care. Those with incomes below 100% FPL will not have to pay any premiums, but those whose incomes range from 100% to 300% FPL will pay premiums based on a sliding income scale. Individuals whose incomes are above 300% FPL and who do not receive insurance from their employer or another source will be able to purchase insurance through the Commonwealth Health Insurance Connector Authority. These insurance plans will be certified by the Connector Authority for affordability and quality. The ability of the uninsured to afford these new insurance products is crucial for the reform plan s success. The survey asked each respondent two questions about the affordability of different insurance plans based on a hypothetical person s income and family size. One-half of the respondents were asked about Commonwealth Care plans for lower income people. The other half were asked about Connector plans for the rest of the uninsured. Each respondent was asked about two plans: one for a single person and another for a family. Yearly incomes for each family were supplied. Pricing and income levels were based on the recently released Commonwealth Care plan pricing. Income levels for the Commonwealth Connector-offered plans were chosen to be just above the 300% FPL cut-off for Commonwealth Care and the prices tested were within a range that included current premiums for employer-sponsored coverage in Massachusetts and prices that have been publicly discussed as premiums targets for Commonwealth Connector plans. In the questions, the Commonwealth Care premiums for a single individual earning $25,000 a year (which is just above 250% FPL) ranged from $50 to $200 a month. For a family of four whose income is $45,000 (which is roughly 275% FPL), the monthly premiums ranged from $150 to $450. The Commonwealth Connector-offered plan premiums for a single individual earning $35,000 a year (which is roughly 350% FPL) ranged from $100 to $400 a month. For a family of four whose income is $70,000 (which is roughly 350% FPL), the monthly premiums ranged from $400 to $1000. Respondents were asked whether the top price was a reasonable one for each person or family. If the respondent said it was not, the price was lowered and the question asked again. This continued until the respondent said the price was reasonable or the bottom price was reached. The survey finds that for all four health plans, a majority of respondents felt the highest price offered was unreasonable (Exhibits 17 20). Only one-quarter to just over one-third of Massachusetts residents felt the highest priced plans are reasonable amounts to pay. However, a sizable majority of the public feels the actual Commonwealth Care plan premiums are reasonable. 4 Seventy-three percent feel that $250 a month is reasonable for a family plan and 83% feel that $100 is reasonable for an individual plan. With regards to the Commonwealth Connector-offered plans, 66% of respondents viewed a family plan price of $600 per month to be reasonable and 78% viewed a price of $200 for an individual plan to be reasonable. These prices are within the range of those that have been discussed as targets for the Connector s affordable products.

20 15 Exhibit 17 Would each of these monthly rates be a reasonable or unreasonable amount to require an uninsured single adult whose income is $25,000 a year to pay for health insurance? Base: One half of respondents $200 is reasonable Percent Saying 37% $150 is reasonable 60% $100 is reasonable 83% $50 is reasonable 93% $50 is unreasonable 5% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Exhibit 18 Would each of these monthly rates be a reasonable or unreasonable amount to require an uninsured family of four whose income is $45,000 a year to pay for health insurance? Base: One half of respondents $450 is reasonable Percent Saying 33% $350 is reasonable 48% $250 is reasonable 73% $150 is reasonable 89% $150 is unreasonable 7% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006 Exhibit 19 Would each of these monthly rates be a reasonable or unreasonable amount to require an uninsured single adult whose income is $35,000 a year to pay for health insurance? Base: One half of respondents $400 is reasonable Percent Saying 24% $300 is reasonable 51% $200 is reasonable 78% $100 is reasonable 95% $100 is unreasonable 3% Don t know responses not shown Harvard School of Public Health/BCBS of Mass. Foundation/ICR September 2006

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